Apixaban at Apex? Aligning Drug Pricing With Value in Cancer-Associated Thrombosis
Authors: Satoko Ito, George Goshua
Journal: Annals of Internal Medicine (2022)

EditorialsJanuary 2023Apixaban at Apex? Aligning Drug Pricing With Value in Cancer-Associated ThrombosisSatoko Ito, MD, PhD, George Goshua, MD, MScSatoko Ito, MD, PhDSection of Hematology, Yale School of Medicine, New Haven, ConnecticutSearch for more papers by this author, George Goshua, MD, MScSection of Hematology, Yale School of Medicine, New Haven, ConnecticutSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M22-3404 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In their article, Gulati and Eckman report a cost-effectiveness analysis of the 3 factor Xa–inhibiting oral anticoagulants used to manage cancer-associated thrombosis (CAT) (1). The analysis compares edoxaban, rivaroxaban, and apixaban to anticoagulation with subcutaneous low-molecular-weight heparin (LMWH) therapy with enoxaparin or dalteparin. CAT is a scourge in which patients have an increased risk for thrombosis due to the malignancy itself and its treatment, as well as an increased risk for bleeding due to anticoagulation, which is needed to mitigate the thrombosis risk. Risks for both thrombosis and bleeding can be amplified further due to patient-specific factors that include age, ...References1. Gulati S, Eckman MH. Anticoagulant therapy for cancer-associated thrombosis. A cost-effectiveness analysis. Ann Intern Med. 2023;176:1-9. doi:10.7326/M22-1258 LinkGoogle Scholar2. Lee AY, Levine MN, Baker RI, et al; Randomized Comparison of Low-Molecular-Weight Heparin versus Oral Anticoagulant Therapy for the Prevention of Recurrent Venous Thromboembolism in Patients with Cancer (CLOT) Investigators. Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med. 2003;349:146-53. [PMID: 12853587] doi:10.1056/NEJMoa025313 CrossrefMedlineGoogle Scholar3. Raskob GE, van Es N, Verhamme P, et al; Hokusai VTE Cancer Investigators. Edoxaban for the treatment of cancer-associated venous thromboembolism. N Engl J Med. 2018;378:615-24. [PMID: 29231094] doi:10.1056/NEJMoa1711948 CrossrefMedlineGoogle Scholar4. Young AM, Marshall A, Thirlwall J, et al. Comparison of an oral factor Xa inhibitor with low molecular weight heparin in patients with cancer with venous thromboembolism: results of a randomized trial (SELECT-D). J Clin Oncol. 2018;36:2017-23. [PMID: 29746227] doi:10.1200/JCO.2018.78.8034 CrossrefMedlineGoogle Scholar5. McBane RD 2nd, Wysokinski WE, Le-Rademacher JG, et al. Apixaban and dalteparin in active malignancy-associated venous thromboembolism: the ADAM VTE trial. J Thromb Haemost. 2020;18:411-21. [PMID: 31630479] doi:10.1111/jth.14662 CrossrefMedlineGoogle Scholar6. Agnelli G, Becattini C, Meyer G, et al; Caravaggio Investigators. 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Health Care in the U.S. Compared to Other High-Income Countries. The Commonwealth Fund; 4 August 2021. doi:10.26099/01dv-h208 CrossrefGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Section of Hematology, Yale School of Medicine, New Haven, ConnecticutDisclosures: Authors have reported no disclosures of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M22-3404.Corresponding Author: George Goshua, MD, MSc, Section of Hematology, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06520.This article was published at Annals.org on 27 December 2022. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAnticoagulant Therapy for Cancer-Associated Thrombosis Shuchi Gulati and Mark H. Eckman Metrics January 2023Volume 176, Issue 1Page: 125-126KeywordsAnticoagulant therapyApixabanClinical trialsDrug pricesHazard ratioHemorrhageLow molecular weight heparinNetwork analysisQuality adjusted life yearsQuality of life ePublished: 27 December 2022 Issue Published: January 2023 Copyright & PermissionsCopyright © 2022 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...